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Deductions cannot be legitimately drawn from so small a number of cases and in the present
year it is not possible to do more than note that the total number of 69 deaths attributed to
"premature birth" represents only a part of the loss of life and damaged physique resulting from
prematurity. Many of the deaths returned as due to "wasting" occur in children prematurely
born, and wasting in its turn predisposes to death from respiratory disease.
Bronchitis and Pneumonia caused 62 deaths in infants. For practical purposes the terms
"bronchitis" and "pneumonia" may be taken as indicating the same disease in infants, since the
causes of both conditions are the same, and post mortem examination of large numbers of cases
has shown that for every 100 babies dying of pneumonia (broncho-pneumonia) only 6 die of true
bronchitis.*
The heavy death roll from these diseases is commonly attributed to "colds" resulting from
the repeated exposure of young infants to inclement weather in the streets or to draughts in the
passages and staircases of their homes. In his report to the Local Government Board Dr.
Foulerton has shown that these supposed exciting causes are negligible in comparison to the
fundamental predisposing causes to be found in conditions of feebleness and malnutrition. Thus
information was obtained as to 30 children dying of bronchitis and pneumonia in Kensington with
the following results:—
Four children were prematurely born and one was born with congenital defects. In 4 cases
the parents were noted as living in great poverty. Five children had ailed for many weeks or
months before the onset of pneumonia. Three were noted as insufficiently or improperly fed, one
having been reared on a diet of Nestle's milk and boiled bread. Many of the causes of malnutrition
are preventible and for this reason there is good hope that the work of the Health Visitors will bring
about a further diminution in the death-rate from respiratory diseases among infants. It should be
added that chronic tuberculosis of the lungs or consumption is extremely rare as a cause of death in
children under the age of 5 years and cannot be held responsible for more than the smallest fraction
of the total number of infantile deaths attributed to pneumonia and bronchitis.* The following
figures show that the reduction in the infantile death-rate from pneumonia and bronchitis has kept
pace with the reduction in the death-rate from all causes :—
Diarrhœal Diseases.—These diseases caused 46 deaths, and are dealt with in a special report
under the section headed "Diarrhœa" (p.p. 21-23).
Wasting Diseases caused 57 deaths. Of these a certain number were no doubt due to
congenital syphilis, whilst others probably occurred in children prematurely born. Improper
feeding is obviously a preventible cause of wasting, and much valuable work has been done in the
past year in referring to charitable agencies cases which, from a medical point of view, if not from
the point of view of the Poor Law Authority, may be correctly described as cases of starvation.
PREVENTION OF INFANTILE MORTALITY.
Notification of Births Act, 1907.— Under this Act, which has now been adopted throughout
London, every birth should be notified to the Medical Officer of Health for the district within
thirty-six hours of its occurrence. Of 3,187 births registered as having occurred within the borough
only 2,258 have been notified. The very general failure on the part of the better classes to notify
the" births of their children is receiving the attention of the Public Health Committee. In the
meantime, the children of the poor are, with few exceptions, notified within the time appointed
by the Act.
Work of the Health Visitors.—Two lady Health Visitors appointed by the Council are
engaged in the work of visiting newly-born babies. In every case where the parents may be reasonably
supposed to be earning less than 40s. per week, the child is visited between the ages of 10 and
*Foulerton, A. G. R. " Pnuemonia in Children." 38th Annual Report of the Local Government Board, 1908-9.
Infantile Deaths per 1,000 Births. 1901—5. 1909.
All causes 144 112
Bronchitis and Pneumonia 26 18